WHO Recommends AGAINST Antibody Tests for Tuberculosis
Currently available serological tests for tuberculosis
lead to misdiagnosis, mistreatment and potential harm to public health -
says a recent WHO policy recommendation. This is for the first time that
the WHO has issued a negative policy recommendation. WHO is urging
countries to ban the inaccurate and unapproved blood tests and instead
rely on accurate microbiological or molecular tests. India’s Revised
National Tuberculosis Control Program (RNTCP) has endorsed WHO’s
advice. The new recommendation comes after 12 months of rigorous analysis
of evidence by WHO and global experts. Ninety-four studies were
evaluated-67 for pulmonary tuberculosis (TB in the lungs) and 27 for extra
pulmonary tuberculosis (TB elsewhere in other organs). Overwhelming
evidence showed that the blood tests produced an unacceptable level of
wrong results - false-positives or false-negatives - relative to tests
endorsed by WHO. Results of several meta-analyses have indicated poor
performance of these tests, and in 2008, an assessment of 19 commercial
assays by TDR—the UN special program for research and training in tropical
diseases–found that none of the assays were good enough to replace sputum
microscopy or as an add-on test to rule out tuberculosis.
While the effect of bad drugs and vaccines are obvious
to all, the wasted resources and negative impact of bad diagnostics are
less apparent. Madhukar Pai, co-chair of the STOP-TB Partnership’s new
diagnostics working group estimates that serodiagnostic kits are used on
at least 1·5 million people with suspected tuberculosis every year in
India with costs amounting to over $US15 million in India alone, compared
with $65 million for the entire RNTCP. A 2006 WHO report found that in
Tamil Nadu and Delhi, less than one-third of patients underwent sputum
examination despite multiple visits while doctors based in west India
relied solely on chest X-rays for diagnosis. "Blood tests for TB are often
targeted at countries with weak regulatory mechanisms for diagnostics,
where questionable marketing incentives can override the welfare of
patients," said Dr Karin Weyer, Coordinator of TB Diagnostics and
Laboratory Strengthening for the WHO Stop TB Department. "It’s a
multi-million dollar business centered on selling substandard tests with
unreliable results." (www.who.int/mediacentre/news/releases/2011/tb_20110720/en/index.html,
The Hindu 29 July)
Journalistic Blunder
The National Committee for Protection of Childs Rights
(NCPCR) has found that the news story that scores of girls were being
converted into boys by a surgical procedure called genitoplasty in Indore
was a figment of the journalists’ imagination. The investigative team sent
by the NCPCR included Dr Dinesh Laroia and V K Tikoo , Dr M Bajpai, senior
pediatric surgeon from AIIMS, Dr Kiran Kucheria, retired head of the
department of anatomy and genetics, AIIMS, and Amit Karkhanis,
medico-legal expert from Mumbai. The NCPCR team also visited Indore
hospitals and spoke to doctors, surgeons, as well as technical staff,
pharmacists, nurses and ward boys. It collected operation theatre records,
case files, pharmacy records – to check the supply of testosterone – and
chromosomal studies, but found absolutely no evidence for the newspaper
story. In an indictment of the newspapers’ editorial review process, the
NCPCR has recommended that "the print media should have a set of protocols
in publishing such sensitive stories and should undertake internal
verification before making them public so as to avoid any kind of
sensation."
It also recommended that the Indian Council of Medical
Research should work with other apex bodies to develop a framework for
holistic management of sex development disorders which have significant
social, psychological and scientific implications. (The Times of India
27 July).